Retrospective analysis of a large-scale cholera outbreak in Sudan

Abstract

Background: Cholera outbreak is a significant public health threat in some parts of Sudan. In 2023, there was a large-scale outbreak in Gadarif State. Aim: To analyse the 2023 cholera outbreak in Sudan and recommend prevention and control measures for the future. Methods: In this retrospective study we conducted an epidemiological analysis of data from suspected and confirmed cholera cases, aged ≥ 2 years, from 138 health centres in Gadarif State, Sudan. Results: A total of 1997 cholera cases were confirmed using rapid diagnostic test between 25 August and 17 December 2023. Most patients (99.2%) had severe watery diarrhoea, and vomiting was reported in over 73% of cases. Dehydration rates were similar for men and women (≈55–60%), average attack rate was 6.7 per 10 000 population. The attack rate varied by locality but not by gender across all age groups. The outbreak lasted 20 weeks and claimed 46 lives, giving a case fatality ratio of 2.6%. Public misconception about water chlorination substantially hindered control efforts. Conclusion: The prolonged period of the outbreak and the high case fatality ratio highlight the need for better laboratory and epidemiologic surveillance as well as better preparedness and response for future outbreaks, along with educational activities to address myths and misconceptions.